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Abd Nour’s triumph over leishmaniasis
25 January 2024 – Abd Nour, a 52-year-old father from Aleppo, has been displaced 3 times with his family owing to the ongoing conflict in Syria. Once a shopkeeper, Abd became a day labourer to support his family after they were forced to flee their home. “For us, it has been very difficult,” he said. “It was hard to make plans not knowing how I would be able to support my family. As a father, I worried a lot.”
In summer 2023, Abd contracted leishmaniasis, which turned his world upside down.
Leishmaniasis remains a major health problem in Syria. Each year, the country typically records 70 000 to 80 000 cases of cutaneous leishmaniasis, the most common form. It is caused by a protozoan parasite that is transmitted to people through the bites of infected sandflies.
The neglected tropical disease has various clinical symptoms and, left untreated, can cause severe lesions, including ulcers. Infection can lead to serious disability and stigma, but timely treatment can prevent such complications. For Abd, the disease caused severe pain that left him unable to walk.
“I was terrified of the thought of passing this illness on to my pregnant wife and young son,” Abd explained.
WHO has been actively supporting the leishmaniasis programme in Syria since 2015, helping families and communities across the country. In 2023, in partnership with national authorities, WHO carried out leishmaniasis control activities in the most affected governorates: Aleppo, Hama and Idlib. This effort involved the indoor residual spraying of more than 73 000 houses, to protect over 369 000 people from the risk of infection. The programme also provides treatment, as well as training for Ministry of Health staff to enhance local capacity for effective case management.
WHO’s support for comprehensive, evidence-based treatment of leishmaniasis is a lifeline for patients. Dr Hassan Al-Zaher, Director of Al-Zahera Polyclinic in Damascus, where Abd was treated, reported that the clinic provided free treatment to 450 leishmaniasis patients in 2023 alone. This was possible thanks to WHO and Ministry of Health efforts.
Dr Iman Shankiti, Acting WHO Representative in Syria, further stressed the importance of comprehensive disease management to tackle leishmaniasis: “Beyond treatment of leishmaniasis, our efforts in Syria include educational campaigns and preventive measures to reduce the burden of this neglected tropical disease.”
Today, Abd Nour has resumed his daily work: “After looking back at my journey, I am thankful for every day. This experience taught me the importance of health and access to quality health care.”
Empowering displaced people in northwest Syria to regain their mental health
3 January 2024 – “After years of suffering, I am finally feeling empowered to regain control over my own destiny,” shared Hana, aged 29 years, who has suffered a series of devastating losses.
A decade ago, Hana was forced to flee her home when fighting intensified close to her village in northwest Syria. She left her relatives without saying goodbye, uncertain if she would ever see them again.
Having taken shelter at Sundian camp in Idlib governorate, Hana, her husband and 3 children struggled to make ends meet. The hardships endured in the camp took a serious toll on Hana’s mental health.
More than 12 years of conflict, displacement, lack of livelihoods and dire living conditions, combined with the February 2023 earthquakes, have been detrimental to the mental health of many people in northwest Syria.
WHO estimates that nearly 1 million people in northwest Syria suffer from a mental health disorder – of which 230 000 people suffer from a severe mental health disorder.
Ongoing cycle of loss
When 7 months pregnant with her fifth child, Hana suffered a miscarriage. The loss haunted Hana and she was left feeling overwhelmed by fear and anxiety.
Six months later, when the devastating earthquakes struck northwest Syria and Türkiye, Hana tragically lost her sister and the sister’s 4 children.
Hana felt trapped in a cycle of loss. She lost her appetite and more than 28 kg in weight and was no longer able to care for her children.
A recovery plan for Hana
Hana’s husband Ahmed saw her mental and physical health decline and was eager to help. He joined an awareness-raising session on mental health and psychosocial support run by Hope Revival Organization, a WHO partner. On learning of the services available, Ahmed went with Hana to the mental health clinic in the camp.
Hana had a series of psychosocial assessments and was prescribed medications and given a recovery plan. This plan included 8 therapy sessions with a psychologist to explore Hana’s emotions, thoughts and behaviours.
Hana helps her youngest son with his homework at Sundian camp, Idlib governorate. Following the successful completion of her treatment, Hana has been able to re-engage in caring for her children. Photo credit: WHO/ Hope Revival Organization Remarkable changes were soon observed in Hana. She regained her ability to care for her children and reconnected with her extended family. Her eating habits improved, and her mood stabilized.
“Mental health services are an absolute necessity given the harsh living conditions in these camps,” said Hana’s psychologist. “The mental health services we provide to Hana and so many others equip them with the skills to manage stress, adopt new, positive thoughts and navigate their emotions.”
Seeing Hana’s progress, her mother also sought support at the mental health clinic.
“My journey has been challenging,” said Hana, “but with these services, it has ultimately led me to a place of joy and strength.”
The need to sustain and scale up support
Mental health care remains scarce in northwest Syria. Only 4 health facilities provide psychiatric services and just 2 psychiatrists serve a population of 4.5 million. WHO has been pivotal in supporting these facilities, through capacity-building, technical supervision and provision of psychotropic drugs and other medicines.
Mental health clinics set up in camps for internally displaced people in northwest Syria provide psychosocial support and therapeutic interventions. Photo credit: WHO/ Hope Revival Organization In 2023, with generous funding from the Central Emergency Response Fund, WHO supported the provision of mental health services for internally displaced people and host communities in northwest Syria. It did so through existing mental health services in primary health care facilities and by setting up specialized mental health clinics and mental health psychosocial support mobile teams.
Mental health clinics set up in camps consist of a resident mental health gap action doctor, 2 psychologists and 3 psychosocial workers. Each clinic serves as a hub for integrated services, offering individual consultations, psychoeducation sessions, and peer support. To extend the clinics’ reach, mobile teams run awareness-raising sessions and provide services in remote areas of northwest Syria.
In addition, the Mental Health and Psychosocial Support Technical Working Group in northwest Syria led by WHO supports mental health and psychosocial assessments, service mappings and the integration of mental health services within primary and secondary health care facilities to ensure greater access to such services.
WHO strengthens health emergencies response in northwest Syria
Training on risk assessment and outbreak investigations. Photo credit: WHO/WHO Gaziantep Field Presence Office5 December 2023, Cairo, Egypt, and Gaziantep, Türkiye – To strengthen the response to disease outbreaks and public health emergencies in northwest Syria, WHO conducted a training on risk assessment and outbreak investigations in Gaziantep, Türkiye.
The training was for 24 health professionals from northwest Syria who are engaged in the implementation of early warning, alert and response network. Led by the WHO Regional Office for the Eastern Mediterranean and the WHO Field Presence Office in Gaziantep, the training ran from 27 to 29 November 2023.
Participants are now equipped with the knowledge and skills to address health risks and acute public health emergencies in a more timely and effective manner.
“The training provided a great opportunity for health actors to work in the same direction and to the same standard operating procedures to better detect, assess, report and respond to public health events,” said Ms Rosa Crestani, Head of Office, WHO Gaziantep, in her opening remarks.
Training participants. Photo credit: WHO/WHO Gaziantep Field Presence Office The training boosted participants’ skills in conducting rapid risk assessments and situation analysis during public health emergencies and acute events in northwest Syria. Health actors from northwest Syria will collaborate with WHO Gaziantep and the WHO Regional Office in future to ensure rapid intervention during outbreaks.
“We hope that this training will also strengthen collaboration between WHO and its partners and among partners themselves, and that the training can cascade down to other partners working in northwest Syria,” said Dr Aura Corpuz, Team Lead, Public Health Intelligence, Health Emergency Information and Risk Assessment Unit, WHO Regional Office.
This training is vital given the severe, long-term disruption to northwest Syria’s health system, which has been made worse by COVID-19, other disease outbreaks, the February 2023 earthquake and renewed hostilities.
Moreover, the political and administrative context in northwest Syria, and the absence of a health ministry, make it increasingly challenging to report through the International Health Regulations (2005). Timely and effective risk assessment and outbreak investigation are thus more important than ever to control diseases and prevent and manage public health emergencies. Such efforts are critical to strengthen health emergency response in this setting.
This training is part of a series of trainings offered by the WHO Regional Office that aims to strengthen the capacities of Member States and territories to conduct rapid risk assessments and public health situation analysis.
WHO and Syrian Ministry of Health joint evaluation mission finds EWARS effective and recommends updates
19 November 2023, Damascus, Syria¬ – WHO and the Syrian Ministry of Health recently completed a joint evaluation of the country’s main disease surveillance system, the Early Warning, Alert and Response System (EWARS). Throughout the crisis in Syria, EWARS has been instrumental in detecting outbreaks of measles, cholera and other diseases and preventing their further spread. Health facilities across Syria submit weekly surveillance data to the Ministry of Health in Damascus for consolidation, analysis and response.
The EWARS mission team meets with local health officials in rural Damascus.
Photo credit: WHO/WHO Syria
The evaluation team, comprising experts from the WHO Regional Office for the Eastern Mediterranean, WHO Country Office in Syria and national counterparts, assessed 46 health facilities and laboratories in 13 Syrian governorates. The team’s preliminary findings indicate that EWARS is working effectively, with high levels of timeliness, completeness and acceptability – particularly at field level.
The team recommended that the list of diseases under surveillance is revised to include case definitions, and that disease thresholds are reviewed. It also recommended efforts to strengthen staff capacity, data quality and feedback loops.
Dr Iman Shankiti, Acting WHO Representative in Syria, said that the evaluation was timely: “The last evaluation of EWARS dates to 2017. This recent assessment is critical to help us ensure that EWARS remains agile and fit for purpose. We are committed to work with the Ministry of Health to strengthen EWARS and make it even more effective.”
Dr Sherein Elnossery, of the Infectious Hazards Prevention and Preparedness unit at the Regional Office, said that EWARS is a lifeline for people in Syria in the face of ongoing conflict and uncertainty. “EWARS has proven to be resilient, even in the face of the devastating earthquake that hit the country this year. By providing early warnings of outbreaks and emerging threats, it helps to save lives and protect the health of communities. I am proud to be part of the team working to strengthen this vital system.”
WHO will use the mission recommendations to develop a plan to strengthen EWARS and further increase its capacity to detect and respond to disease outbreaks and emerging threats.
